i'm dr amanda orthodontist at straightsmile solutions we help dentists launch and scale
orthodontics in their practice today we'll be sharing some content from a webinar
that was co-hosted with ms tamara thomas a facial physique oral myofunctional therapy
to connect with ms thomas please use this qr code or visit www.facialphysique.com
if you want to help with an orthodontics case please
contact dr amanda with at straight smile solutions www.straightsmilesolutions.com
or click on her qr code
working on neuromuscular re-education of the head neck and throat muscles with other professionals
yes in a nutshell it's basically exercises but it's more it's deeper than that as far as
coordination and which relates to airways so um we do assess for tongue tie versus tongue
thrust so if there's a restriction that we suspect we do work with the professional
it can be an ear nose and throat physician it can be a dental professional a dentist
who would do the release and do the assessment i'm kind of giving you the red flags of yeah
there looks like there's a restriction there but they definitely have to give you the diagnosis
um and the reasons why so um you do want to make sure so
even as in hygiene school right i wasn't taught about tongue tie and a lot of us in dental schools
and stuff aren't taught about it in debt that was not right so you do want to make sure that you're
referring to somebody that understands it and has had extra training in it so one of the main
places is the breath institute so it is an ear nose and throat physician his name is doctors
soggy i don't know if you guys you know i talked about you know the um
i talked about him last time in that tongue range of motion scale that i was just going
over he's the one that helped develop that um at stanford long along with other professionals
but he's kind of on the forefront with everything and he has a technique of releasing the tongue and
he trains others and so i usually will refer to somebody that has been trained by him you can do
that by going to the breath institute dot com and there's a list of providers that have been through
so then you know they kind of kind of speak the same language they understand that functional
therapy they you know collaborate together so so i explained tongue tie is a physical problem that
frenulum underneath the tongue is just short it's not allowing the range of motion to be
where we need it to be for my functional therapy and that's indication of the tongue swinging
like another time the jaw swinging like i showed you um and not having full range of motion by
opening wide and being able to lift the tip of the tongue to the roof of the mouth and then also that
suctioning would be the back of the tongue so this is the two ways so yeah tongue tie does it look
like there's something some kind of restriction that may be present there um for sure i would have
you evaluated by a provider tongue thrust can just be tongue load muscle tone so we see this a lot
um with uh just muscles that aren't strong so a child that may not be tied um but has had severe
allergies their whole life and only way they could breathe into their mouth well if they're
breathing through their mouth their tongue is low which means they're not utilizing their tongue
to its fullest potential so we'll see a lot of low muscle tone um so tongue tie tongue thrusts
they usually go hand in hand more often than not on rare occasions sometimes there won't be any
restriction but they'll definitely be low tone and the reason why it's important is because obviously
relapse can occur with orthodontics or um not a wide palette like we'll go over
interrupt me if you need me to at all okay if you have any questions or anything so myofunctional
therapy are our main focus is airway tongue tie and tongue thrusts are just clues that this is
going on so we work on full body health so we're not the end-all be-all we are part of a team of
different people you have the release provider you have the orthodontist you may have the ear
nose throat physician you may have the myofascial release person you may have a chiropractic um you
can't just do myofunctional therapy and then like everything is gone so it's kind of like peeling
the onion there's different layers of dysfunction that have occurred all these years and we're just
getting back to that root cause of why did you develop that way but our main focus is that there
isn't any obstruction and that we're supporting the airway because obviously airway life
so again i always kind of beat this thing to the patient no it's good time we're done that
you're always breathing through your nose lips are always closed your tongue is always on the
roof of the mouth without those two points that i was showing you without touching any teeth
and that you're swallowing without the tongue pushing against the teeth
so we're limiting that thrust in an infant if we can if they have that then usually the
tongue the craniofacial growth will develop um nicely if there's restriction or any compensations
then we start to see that craniofacial development have you know not optimal
so this is just a diagram of where the tip of the tongue should sit so the oval is
the spot can you see my cursor i can see it i'm trying to do that and i'm like i can't do that
so that's good and then the back of the tongue should be completely in the in the roof of the
mouth the idea too is that if the tongue is completely at the roof of the mouth the soft
palate will suction forward at night time so we don't have that tongue going going back uh again
that's not comfortable yeah i can't do that yeah then it would start to get snoring signs of sleep
breathing um so the the tip of the tongue on the first spot so in therapy we call this oval
the first spot and i call the last one the last two the second spot so we want to work on that
but the main goal is to create awareness so they can tell you 95 of therapy is awareness
i always put this in here because people are like oh my kid doesn't mouth breathe but even
if there's just a tiny bit of opening of the lips we want those lips completely closed
100 and lip then there's load lip tone and mouth breathing can occur
so these are just um diagrams of what we want it to look like we want there to be a nice u-shaped
palette versus a v-shaped palette i explained to patients that there's a v-shaped palette a the
tongue can't be at the roof of the mouth there's not a large cage for it there's more crowding a
lot of times teeth will have to be taken out and the goal is we want to create that so we want an
air refocus provider to where they're gonna optimize the amount of space that's in there
if the tongue is at the roof of the mouth then that's the goal is that it's able to
be nice and wide and that you're closing gaps versus trying to create space have you seen this
little boy i think i was going over this probably i think you showed me that him last time or i saw
him on your website or something like that yeah he looks familiar yeah that looks super sdb like to
the max lips everything tap lips so dysfunction what we call our facial dysfunction is the loud
tongue tones if you see the tongue it's in between the teeth there's a little bit of crowding in
those baby teeth too um you want there to be nice wide uh area also the nasal passages nostrils
they're vertical versus horizontal that just is an indication that the roof of the mouth isn't very
wide because the roof of the mouth is the floor of the sinus um and then you can see just looks tired
it can be what we call venous pooling underneath the eyes i mean sleep isn't great so just a lot of
dysfunction oral dysfunction so our goal is that those four goals those lips are going to be closed
the tongue is going to be at the roof of mouth and we can really help this child grow accordingly in
adults um biofunctional therapy has been studied and uh on how this how myofunctional therapy
affects adults uh with sleep disorder breathing and so it's about 50 so it won't
cure patients of sleep apnea obviously we want them to talk with their physicians
but a lot of times patients won't wear their cpap machine because it's uncomfortable
and if we can get them to breathe through their nose usually they can be pretty compliant with
the cpap the goal is that they have less ethnic events during the night and that
their cpap can be titrated accordingly so they're getting more oxygen for sure
so again dysfunction how does it create problems poor facial growth
won't support a healthy airway it can dental problems crowding increase risk of cavities
if there's mouth breathing going on because that ph balance is completely different enamel wear
if there's a lot of grinding or clenching going on a recession for some patients that may clench
periodontal disease uh can be affected obviously oral hygiene plays a role in all of that too but
those are some of the things that can happen increased risk of sleep disorder breathing
including sleep apnea chronic pain like i was explaining the shoulders if there's a forward
head posture that bowling ball 10 pounds of the head being forward it's going to put pressures
on the neck muscles and then eventually tmj issues if there's compensation and the proper
muscles aren't being used and there's swinging of the mandible i think we went over this as
well mouth first now breather versus nasal breather uh just the cheekbones everything
is nice and wide versus the retrognathic everything grows wide instead of nice and long
so we walk through the evaluation i explained um
birth why we earlier so i don't have to go too much into depth about this but
birth and feeding why those are important to ask us questions oral habits if there's
anything that's causing the tongue to be at the roof or the floor of the mouth ear infections um
if there's improper swallowing a lot of times there can be the regurgitation and if there's
chronic ear infections then there's probably something going on with the tongue as well
speech therapy a lot of times if children are in speech therapy without it being resolved
then it might just be that there's a restriction present
range of motion isn't great yeah so they're not able to get the tongue where they need
it to be to create those sounds so we need to make sure that we are um
assessing for that and and referring to speech therapists if necessary i think it's fascinating
that they never connected the dots between occlusion for me the speech therapy you know
impossible restrictions so interesting yep i'm in the same boat as you that's why i'm in this field
so digestive issues we didn't go too much into this but patients can have
a lot of constipation a lot of bloating if they're not eating correctly correctly if they're
swallowing air or aphasia so if the tongue's not at the root of the mouth their mouth breathing
if they're eating fast we can breathe through their mouth and if they can't breathe through
their nose they're going to swallow incorrectly so it's just like a domino effect of everything
breathing if there's a lot of allergies so if you're taking
a lot of like the flonase or the zyrtec con consistently then we
want to kind of get to the bottom of that okay again if we need to refer to
an allergist or an ent if there's any issues going on there for you you sound like you're doing
pretty good so as far as ent no needing to do any of that more of the allergies and um all of that
do you use humidifier or anything like that no there's plenty of humidity here that's not a
problem i mean a purifier oh air purifier um my son has one in his room because he gets
allergies but i never put one in my room but maybe i should perfect what about like changing your um
pillow and stuff how often do you do that change oh you throw away the pillow and get a new one
i really should do that more often what is your recommendation well everybody's a bit different
it depends on what kind of pillows you're getting like you know if if you have a down pillow that
might create more allergies for you if you're putting your head i'll show you the amount of
pillows we have on our bed we have probably 20 pillows on our bed we don't sleep with them all
but there's all kinds of pillows so i mean oh the one i sleep on i've moved from a down
pillow to like a cooling gel pillow which i think lasts longer yeah so that's what i sleep on but i
mean there's pillows everywhere so they're not for me they're for somebody else so okay gotcha
so we'll kind of set that you know if there's an issue with mouth breathing then we assess
that kind of stuff like well let's see what's in your environment what may be causing all of that
so we went through cavities you know with the mouth breathing and there isn't uh increased
risk of cavities if you're changing the ph balance if there's any extracted teeth
um if you had extraction of the baby teeth then your jaw may have not been large enough
that's why i asked that at that point i had plenty spacing that was not the problem generalized
spacing plenty wide jaw so um i think that they just weren't the roots weren't resolving so so um
and then wisdom teeth so the idea is that our jaw should grow wide enough to where everything
can be supported so i know it's very common but even if there's bis bicuspids that are
extracted that will reduce the amount of tongue space in the palate from a mild functional
point oh i took the third molars out because i i can generally only had two so there was no point
in having them so i just took them out before it became an issue yeah perfect yeah um so yeah so
it looks like with your photos you have enough space so that's not really one of our concerns
again looking at chewing and swallowing if there's any thrusting forward any use of muscles that we
shouldn't be using and you had a lot of flip not a lot but a good amount of lip movement
some patients will hold their breath and then breathe when they're done drinking or eating
so we don't want any breath holding either oh i want you to be able to breathe through your nose